Digital Pulse Oximetry for the Screeing of Lower Extremity Arterial Disease

Dae Moo Shim; Sung Kyun Oh; Jung Nam Kwon

doi:10.4184/jkss.2014.21.1.36

Journal List > J Korean Soc Spine Surg > v.21(1) > 1076041

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Shim, Oh, and Kwon: Digital Pulse Oximetry for the Screeing of Lower Extremity Arterial Disease

Original Article

Journal of Korean Spine Surg 2014;21(1):36-40.

Published online: 21 March 2014

DOI: https://doi.org/10.4184/jkss.2014.21.1.36

Digital Pulse Oximetry for the Screeing of Lower Extremity Arterial Disease

Dae Moo Shim, M.D., Sung Kyun Oh, M.D., Jung Nam Kwon, M.D.^∗

Department of Orthopedic Surgery, School of Medicine, Wonkwang University, Iksan, Korea

^∗Division of Vascular Surgery, School of Medicine, Wonwang University, Gunpo, Korea

Institute of Wonkwang Medical Science. Iksan, Korea

Corresponding author: Sung Kyun Oh, M.D. Department of Orthopedic Surgery, School of Medicine, Wonkwang University Sanbon Hospital, Sanbondong, Gunpo city, Gyeongido, Korea TEL: 82-31-390-2992, FAX: 82-31-390-2244

Received 15 January 2013 Revised 26 February 2013 Accepted 28 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

The aim of the study was to investigate the usefulness of a handheld digital pulse oximetry in the detection of lower extremity arterial disease.

Summary of Literature Review

Pulse oximetry is a well-established method for noninvasive evaluation of arterial oxygenation.

Materials and Methods

A Retrospective study was performed in 45 patients with lower extremity arterial disease. We compared the accuracy of a handheld digital pulse oximetry and the ankle brachial index (ABI). Digital pulse oximetry was conducted for 42 patients with 84 limbs to measure the SaO2 of their index fingers and big toes in supine position. The ABI was defined as abnormal if it was less than 0.9. Pulse oximetry of big toes was defined as abnormal if the SPO2 was less than 96% or it was more than 2% lower than that of the index finger.

Results

Digital pulse oximetry had a sensitivity of 47%(95% CI, 34-60%) and specificity of 86%(95% CI, 64-96%). ABI had a sensitivity of 49%(95% CI, 34-64%) and specificity of 95%(95% CI, 72-99%). Positive predictive values were 91%(95% CI, 74-98%) for digital pulse oximetry and 96%(95% CI, 77-99%) for ABI. Negative predictive values were 37%(95% CI, 24-51%) for digitial pulse oximetry and 43%(95% CI, 25-72%) for ABI. In 22 cases with acute ischemicwere the sensitivity 73%, the specifity 100%, the positive predictive value 100% and the negative predictive value 79%.

Conclusions

Handheld digital pulse oximetry of the big toes seems as accurate as ABI to detect lower extremity arterial diseases. The combination of both will help to distinguish low extremity arterial disease and spinal radiculopathy.

Keywords: arterial disease, pulse oximetry, ankle brachial index

REFERENCES

1. Chae IJ. Lumbar spinal stenosis. J Korean Soc Spine Surg. 1999; 6:220–7.

2. Lee HM. Pathophysiology of Lumbar Spinal stenosis. JKorean Soc Spine Surg. 2000; 7:100–5.

3. Brearley S, Shearman CP, Simms MH. Peripheral pulse pal-pation: an unreliable physical sign. Ann R Coll Surg Engl. 1992; 74:169–71.

4. Barnhorst DA, Barner HB. Prevalence of congenitally absent pedal pulses. N Engl J Med. 1968; 278:264–5.

5. Criqui MH, Fronek A, Klauber MR, Barrett-Connor E, Gabriel S. The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation. 1985; 71:516–22.

6. Joyce WP, Walsh K, Gough DB, Gorey TF, Fitzpatrick JM. Pulse oximetry: a new non-invasive assessment of peripheral arterial occlusive disease. Br J Surg. 1990; 77:1115–7.

7. Feigelson HS, Criqui MH, Fronek A, Langer RD, Molgaard CA. Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in a defined population. Am J Epidemiol. 1994; 140:526–34.

8. Jawahar D, Rachamalla HR, Rafalowski A, Ilkhani R, Bharathan T, Anandarao N. Pulse oximetry in the evaluation of peripheral vascular disease. Angiol-ogy. 1997; 48:721–4.

9. Johansson KE, Marklund BR, Fowelin JH. Evaluation of a new screening method for detecting peripheral arterial disease in a primary health care population of patients with diabetes mellitus. Diabet Med. 2002; 19:307–10.

10. Ouriel K, McDonnell AE, Metz CE, Zarins CK. Criti-cal evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery. 1982; 91:686–93.

11. Hauser CJ, Klein SR, Mehringer CM, Appel P, Shoemaker WC. Assessment of perfusion in the diabetic foot by regional transcutaneous oximetry. Diabetes. 1984; 33:527–31.

12. Maser RE, Wolfson SK Jr., Ellis D, et al. Cardiovascular disease and arterial calcification in insulin-dependent diabetes mellitus: interrelations and risk factor profiles. Pittsburgh Epidemiology of Diabetes Complications Study-V. Arterio-scler Thromb. 1991; 11:958–65.

13. Parameswaran GI, Brand K, Dolan J. Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. Arch Intern Med. 2005; 165:442–6.

Figures and Tables%

Fig 1.

Handheld digital pulse oximetry.

Fig 2.

Receiver operating characteristic (ROC) curve for the pulse oximetry test and the ankle brachilaindex(ABI). (A) ROC curve for pulse oximetry test, Area under the curve was 0.321 (95% confidence interval:0.205-0.438,p<0.014). (B) ROC curve for ABI, Area under the curve was 0.375 (95% confidence interval:0.246-0.505,p<0.114).

Table 1.

Demography of patients.

Number of Patients(limbs)	45 (90 limbs)
Average Age (yr)	66.9(40-92)
DM,n (%)	31(69%)
Hypertension,n(%)	32(71%)
Known heart disease,n(%)	11(24%)
Treatment option Surgery	28(62%)
Conservative	17(38%)

Table 2.

Results for Pulse oximetry test, Ankle brachial index.

Test Results	Arterial disease Present No.(%)	Arterial disease Absent No.(%)	Sensitivity (95% CI), %	Specificity (95% CI), %	Positive Predictive Value(95% CI), %	Negative Predictive Value(95% CI), %
Pulse oximetry test			47(34-60)	86(64-96)	91(74-98)	37(24-51)
Positive	29(35)	3(4)
Negative	33(39)	19(23)
ABI			49(34-64)	95(72-99)	96(77-990	43(28-72)
<0.9	23(35)	1(2)
≥0.9	24(36)	18(27)

CI; confidence interval ABI; ankle brachial index

TOOLS

Similar articles